Factors Associated with Medication Adherence among Patients with Schizophrenia in Mekelle, Northern Ethiopia
Open accessAbstract
BACKGROUND: Non-adherence to antipsychotic medication has a negative impact on the course of illness resulting in increased risk of relapse, rehospitalization and suicide, and increased costs to healthcare systems. The objective of this study was to investigate factors associated with medication adherence among patients with schizophrenia at Ayder Referral Hospital and Mekelle Hospital in Mekelle, Tigray region, Northern Ethiopia. METHODS: The study was a cross-sectional survey in which sociodemographic characteristics, drug attitudes, insight and side effects were measured and explored in terms of their relationship with medication adherence. A structured questionnaire as a data collection tool was used. Data were analyzed with the help of SPSS Version 20.0. RESULTS: A total of 393 patients participated, 26.5% were non-adherent to their antipsychotic medication. The factors significantly associated with better adherence were positive treatment attitudes (AOR = 1.40, 95% CI: 1.26, 1.55), fewer side effects (AOR = 0.97, 95% CI: 0.94, 0.99), awareness of illness (AOR = 1.44, 95% CI: 1.12, 1.85) and the ability to relabel symptoms (AOR = 1.57, 95% CI: 1.19, 2.07). However, khat chewers (AOR = 0.24, 95% CI: 0.09, 0.68), being illiterate (AOR = 0.13, 95% CI: 0.03, 0.47) and older age group (AOR = 0.03, 95% CI: 0.01, 0.16) were associated with less medication adherence. CONCLUSIONS: A high prevalence of medication non-adherence was found among patients with schizophrenia. Intervention strategies focused on educating the patients to better understand the illness, medications and their potential side effects might be useful in improving adherence to antipsychotic medication treatment.
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Psychiatric patients with lower education level (lower than secondary education) were more likely to be non-adherent to psychotropic medication compared to those with higher education level in six studies.
“In six studies, psychiatric patients having lower education level (lower than secondary education) were more likely to be non-adherent to their psychotropic medication compared to those patients having higher educational level [23, 40, 44, 52, 56, 57].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
Patients aged 60 years and older were more likely to be non-adherent to their medication in three studies.
“In three studies, patients aged 60 years and older were more likely to be non-adherent to their medication [23, 55, 58].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
Patients having negative attitude towards their medication was a factor associated with psychotropic medication non-adherence in four studies.
“Patients having negative attitude towards their medication was a factor associated with psychotropic medication non-adherence [23, 25, 39, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
Psycho stimulants (e.g., cigarette smoking) was a factor associated with psychotropic medication non-adherence among major psychiatric patients in three studies.
“In three studies, psycho stimulants (e.g., cigarette smoking) was a factor associated with psychotropic medication non-adherence among major psychiatric patients [23, 25, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
Having a history of concurrent alcohol dependency was the main factor associated with psychotropic medication non-adherence in six studies.
“In addition, in six studies, having a history of concurrent alcohol dependency was the main factor associated with psychotropic medication non-adherence [23, 25, 37, 47, 64, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
Both psychostimulant and psycho-depressant substances misuse were associated with psychotropic medication non-adherence in eight studies.
“In eight studies, both psychostimulant and psycho-depressant substances misuse were associated with psychotropic medication non-adherence [23, 27, 29, 37, 42, 43, 58, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
Psychotropic medication non-adherence was associated with medication-related side-effects in several studies.
“In several studies, psychotropic medication non-adherence was associated with medication-related side-effects [11, 22–25, 28–30, 32–37, 39, 44, 50, 52, 55, 64, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
Khat chewing was a factor associated with psychotropic medication non-adherence among psychiatric patients in three studies conducted in Ethiopia.
“Likewise, three studies conducted in Ethiopia [23, 25, 65] have reported that “Khat” chewing was a factor associated with psychotropic medication non-adherence among psychiatric patients.”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
Patients' lack of insight about their illness and medication was a common factor associated with psychotropic medication non-adherence in seven studies.
“In seven studies, patients’ lack of insight (level of awareness or understanding) about their illness and medication was a common factor associated with psychotropic medication non-adherence [21, 23, 28, 39, 40, 50, 51].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [23]
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“Additionally, the inclusion criteria varied, such as including only patients aged 18—65 and those who had been on continuous therapy for at least three months prior to the study [16], which may also have influenced the observed differences.”
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Risk factors for readmission among a cohort of psychiatric inpatients in Lilongwe, Malawi
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“Intentional medication non-adherence is common among psychiatric patients, especially those with schizophrenia (Eticha et al. 2015), which was the most common diagnosis among this cohort.”
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“With respect to the regional states, five studies were conducted in Addis Ababa [46–50], five in Oro-mia [45, 51–54], three in Amhara [25, 55, 56], and two each in Tigray [57, 58] and Harari [28, 59].”
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“AMARS score equal to 3 or above indicates adherence, and non-adherence is defined as scores less than or equal to 2 [18].”
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“, khat and alcohol), the severity of the psychotic symptoms, lack of social support, cognitive impairment, and inadequate therapeutic alliance [4, 16, 17, 19, 20].”
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“[10] Extensive studies have found that poor insight in schizophrenia was associated with poor medication compliance([11-15]) and higher risk of relapse and readmission 17] while good insight was closely correlated with better treatment compliance.”
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“This is because once they not only understand that the disease causes many problems, but they are also gain deeper insights into drug efficacy, phenomena that consequently promote their adherence to medication as previously reported [22, 30].”
ResultTamene, F. B., Sema, F. D., Mihiretie, E. A., Solomon, T., & Sendekie, A. K. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-074112 · Cited by 7 · see citing works
Dameery, K. A., Valsaraj, B. P., Qutishat, M., Obeidat, A. A., Alkhawaldeh, A., Sabei, S. D. A., Omari, O. A., ALBashtawy, M., & Qadire, M. I. A. (2023) · SAGE Open Nursing · doi:10.1177/23779608231197269 · Cited by 6 · see citing works
Does religiosity in persons with schizophrenia influence medication adherence
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“[22,23] When we look at the prevalence of nonadherence from the mean reported figure of 50% across different studies, the nonadherence rate in the present study is lower.”
Addisu, Z. D., Demsie, D. G., Tafere, C., Siraj, E. A., Yazie, T. S., Yimer, E. G., Alemu, N. G., Milikit, Y. Z., Wabela, B. N., Yismaw, M. B., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-21647-6 · Cited by 5 · see citing works
“Additionally, studies by Tadele Eticha et al. 35 , Schadrack Ntirenganya et al. 36 , Merhawi Bahta et al. 37 , Maigari Yusufu Taru et al. 38 , and Irene A. Kretchy et al. 39 explored factors influencing non-adherence, including the role of caregivers’ psychological distress and the extent of…”
Ding, R., He, P., & Zheng, X. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.914245 · Cited by 5 · see citing works
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“46,47 However, it is crucial to acknowledge that other factors, such as socioeconomic background and medication characteristics, can also significantly influence treatment adherence.”
Antipsychotic medication non-adherence and its determinants among out-patients with schizophrenia
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“This is in tandem with findings from previous studies 20,21,23,29 .”
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Akses Pelayanan Rumah Sakit Menjadi Faktor Dominan Kepatuhan Minum Obat pada Penderita Skizofrenia
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“Some studies reported a higher prevalence of Akathisia among females and Younger age both sex [27, 31, 37].”
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Faktor-Faktor yang Mempengaruhi Kepatuhan Minum Obat Pada Pasien Skizofrenia
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Adherence to Pharmacological Treatment Among Patients with Schizophrenia
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NON-ADHERENCE TO TREATMENT AMONG SCHIZOPHRENIC PATIENTS
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“Psychiatric patients often struggle with insight into their diagnoses [27–29], which frequently leads to poor medica - tion adherence [30–32 ].”
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“On the contrary, a research finding from Mekelle showed that being older is associated with medication non–adherence [16].”
InfluentialAmatayakul, A., Purnama, H., & Maneerat, S. (2016) · International Conference on Advances in Economics, Social Science and Human Behaviour Study (ESSHBS) · doi:10.15224/978-1-63248-098-9-33 · Cited by 2 · see citing works
“The consequences of non-adherence in patients with schizophrenia included greater risk of relapse, hospitalization, longer time to remission, suicide and increased costs to healthcare systems [8], [10], [19], [34].”
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“[13] Another study in Bangladesh depicted about 87% of the respondents were non-compliant to medications which can be explained by psychopathology of the disorder itself, poor health literacy, and poor status of psychoeducation.”
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Drug therapy problems in patients with schizophrenia: A cross-sectional study
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“24 In Ethiopia, studies regarding DTPs in patients with schizophrenia are generally insuf fi cient.”
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“Many studies have associated nonadherence with adverse medication effects (Eticha et al., 2015; Hibdye et al., 2015; Mert et al., 2015), and others have identified forgetful-ness regarding dosage or timing as a frequent cause (Endale Gurmu et al., 2014; Moritz et al., 2013; Tesfay et al., 2013).”
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“Semahegn et al in a meta-analytic study reported that 56% patients of schizophrenia were non-adherents.(31,32)”
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Attitude towards adherence to long term therapy
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“(25) In the other study by Lifson conducted in Ethiopia, Ethiopians with HIV/AIDS had high levels of adherence (95%).”
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ผลของการบรบาลทางเภสชกรรมตอผลลพธทางคลนก และผลลพธแบบองครวมในผปวยจตเภท
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“Educational status also appeared to be a determining factor in existing literature, four studies found that psychiatric patients with lower levels of education (below secondary education) were more likely to be non-adherent compared to those with higher educational attainment [23-26].”
Analysis of Medication Compliance and Reasons for Patients with Schizophrenia in the Community
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Comprehensive Analysis of Clinical Factors Affecting Drug Compliance in Schizophrenia
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“43,44 When patients fail to recognise their condition as a mental illness, they tend to be inconsistent with their treatment, which exacerbates both their symptoms and overall functioning.”
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“46,53 Unintentional medication nonadherence, often attributable to forgetfulness, is a recognized challenge in psychiatric care.”
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“Studies report that medication non-adherence affects roughly 40–60% of individuals with schizophrenia, with some estimates ranging from 20% up to 85% (Dikeç & Kutlu, 2014; Eticha et al., 2015 ).”
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“47 In addition, employed participants demonstrated the highest levels of medication adherence, whereas students exhibited the lowest adherence.”
- Authors
- Eticha, T., Teklu, A., Ali, D., Solomon, G., & Alemayehu, A.
- Affiliations
- Mekelle University (ET)
- Corresponding author
- Eticha, Tadele
- ORCID
- Eticha, Tadele
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-03-27
- Volume
- 10
- Issue
- 3
- Pages
- e0120560
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4376899
- OpenAlex
- W2113276173
- Cited by
- 103
- References
- 31
- Citations by year
- 2026: 3 · 2025: 13 · 2024: 9 · 2023: 9 · 2022: 11 · 2021: 12 · 2020: 11 · 2019: 9 · 2018: 10 · 2017: 3 · 2016: 11 · 2015: 2
- FWCI
- 10.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- medication adherence, schizophrenia, antipsychotic drugs, treatment attitudes, adverse drug reactions, disease awareness, khat chewing, illiteracy, Mekelle, Ethiopia
- MeSH terms
- Adolescent, Adult, Awareness, Cross-Sectional Studies, Ethiopia, Female, Humans, Male, Middle Aged, Patient Compliance, Prognosis, Surveys and Questionnaires, Risk Factors, Schizophrenia, Antipsychotic Agents, Prevalence, Drug Monitoring, Young Adult
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